Dr. Howard Fillit has come up with a low-cost way to fend off, and even reverse, what most people view simply as the inevitable ravages of age: He feeds people.
Up to 40 percent of the scores of very sick, older patients Fillit sees at Mount Sinai Medical Center are malnourished, he said, even though they _ and their families and nursing aides, when they are lucky enough to have either _ usually do not realize it.
In many cases, he said, their bad diet has caused, or at least severely worsened, their pneumonia, their heart trouble or even their dementia.
"If they were objective, they would see themselves as skeletons," said Fillit, who runs Sinai's Geriatric Evaluation and Treatment Unit. "But they just see themselves as old."
The extent of malnutrition among older people in general is a murky battleground for their advocates, public health officials and assorted experts. While some nutritionists estimate that 50 percent of all older Americans open themselves up to a host of diseases by not eating enough of the foods they need, very little is known about the problem.
Doctors and nurses who are not trained to detect malnutrition in older people often fail to. "We can't even define malnutrition well for elderly people," said Dr. James Cooper, a geriatrician at the National Institute on Aging, part of the National Institutes of Health. "We think that much more malnutrition occurs that is not labeled or obvious."
But there are studies _ like one conducted by Fillit, who plans to publish his results in the next few months _ that suggest that malnutrition runs high among older people who require hospitalization. For example, hospital studies have shown that between 30 percent and 61 percent do not receive the protein they need.
There are areas of general agreement. Because they lose their teeth or their sense of taste as they age, or because they cannot climb three flights of stairs to their apartments with a cane in one hand and a shopping bag in the other, older people, particularly the poor, are more likely than younger people to eat badly; and eating badly makes healthy seniors sick, and sick seniors die.
Hence the living skeletons that keep turning up on Fillit's doorstep. "Every day they come in, and the primary diagnosis from a geriatrician's point of view is malnutrition and social impairment," he said. "What good is it going to do to give them the right antibiotic for pneumonia and send them back home?"
Last week in Fillit's ward, a 90-year-old woman with sunken cheeks and spidery limbs clung with both hands to the metal rail of her bed, as though she feared she would blow away. She weighed 77 pounds. Because she rejects food and has difficulty chewing, it takes a very patient nurse an hour to feed her. "Her home attendant just wasn't feeding her," Fillit said.
Congress passed a bill this summer to create a three-year, $9-million program to assess malnutrition among older people and to determine if the government could save money by regularly testing them for malnutrition to head off more costly hospital stays later. But the bill was attached to legislation to reauthorize funding for the National Institutes of Health, which President Bush vetoed for reasons unrelated to the program.